FAQs About Kidney Rejection
If you are a kidney transplant patient, you probably have many questions about how to keep your new kidney healthy. Here, we have compiled the most frequently asked questions about kidney transplant rejection, along with some helpful resources for more information.
Be sure to follow the advice of your kidney transplant healthcare team. If you believe you may be experiencing kidney transplant rejection, contact your doctor immediately.
Your body’s immune system protects you against biological entities that it views as ‘foreign’ to you. Kidney transplant rejection is an immune system response in which a transplant recipient’s body recognizes a transplanted kidney as a foreign object and tries to destroy it. This can cause a decline in the kidney’s function and may result in the loss of the organ.
There are three primary types of kidney transplant rejection: hyperacute, acute, and chronic rejection. Hyperacute rejection occurs immediately after transplantation, while acute rejection can happen within the first year, and chronic rejection is a long-term process that occurs over several years.
Silent rejection, also known as subclinical acute rejection, or subAR, is a type of transplant rejection that progresses slowly, often without obvious symptoms.
There are several known causes for kidney transplant rejection. These include:
- Immunological mismatch. Sometimes a transplant recipient’s immune system recognizes the transplanted kidney as foreign due to human leukocyte antigen (HLA) differences. These are genetic variations in the HLA genes that influence immune responses and other biologic processes.
- Non-compliance with medications. If a transplant patient fails to take prescribed immunosuppressive medications, their immune system may begin to attack the transplanted kidney.
- Infection. Infections can trigger an immune response affecting the kidney.
- Ischemia-reperfusion injury. Kidney transplant process can cause temporary damage.
- Vascular problems. Blood vessel issues can impair kidney function.
- Antibody-mediated rejection: In some cases, antibodies from recipients can cause chronic organ rejection.
If you are diagnosed with kidney transplant rejection, it is vitally important to follow the advice of your transplant team. They will create a plan to monitor your kidney function and they will prescribe medications to protect your kidney. The goal of treatment is to balance the suppression of your immune system while minimizing the risk of infections and other side effects of immunosuppressive therapy. They will also suggest possible lifestyle modifications and the treatment of complications like hypertension.
In some cases, if rejection cannot be controlled, your doctor may discuss other options, including dialysis or another kidney transplant.
Common signs of rejection may include fever and other flu-like symptoms; pain, tenderness, and swelling in the kidney area; weight changes; a decrease in urine; and fatigue. These symptoms are signs of clinical rejection, also called acute rejection. By the time your body shows these signs, damage has already been done to your kidney. Contact your doctor immediately if you have any of these symptoms.
Research shows that the rejection process begins well before symptoms develop, with what we call “silent” rejection, or subclinical acute rejection (subAR). In subAR, you will likely feel normal.
Several tests can assess your kidney health, including your serum creatinine and immunosuppression drug level. Research shows that serum creatinine is a late indicator of kidney injury, meaning that damage has already been done by the time this test shows a positive result.
A biopsy can ultimately diagnose subAR, but biopsies are painful and invasive.
That’s why Transplant Genomics created TruGraf Kidney and TRAC Kidney, non-invasive tests that help identify “silent” subclinical acute rejection as early as possible.
TruGraf is a gene expression profile test that looks at the 120 genes that increase or decrease to correspond with your immune system response. We look at the gene expression profile from your blood sample and compare it against a reference profile to see whether your profile most closely matches a profile free from rejection or not. The reference profiles were determined from several thousand samples from several hundred transplant recipients.
With a TX result, you are on the right track and can be confident with a TX result that you have achieved Transplant eXcellence! Continue to achieve this confidence for the life of your kidney with routine surveillance testing using TruGraf.
Keep up with your immunosuppression, diet, exercise, and hydration, and other guidance from your physician. If at any time you start to experience symptoms of active rejection, contact your clinician immediately.
Don’t panic! Your provider may repeat the test or continue to monitor your lab work results closely. In some cases, your clinical team may recommend a biopsy to determine if repeated not-TX results combined with other clinical factors is truly indicative of subAR.
TRAC™ Kidney is a noninvasive donor-derived cell-free DNA (dd-cfDNA) blood test for evaluating “active” or acute rejection. The current gold standard method of rejection diagnosis is biopsy. TRAC™ utilizes a liquid biopsy to measure the percentage of dd-cfDNA in the transplant recipient’s plasma and eliminates potential complications that biopsies can cause for the patient.
In the simplest terms, if you were a transplant patient, you would want to have TruGraf® ordered for you to make sure your immune system is not “silently rejecting” your new kidney without any outward indication. Silent rejection impacts up to 25% of kidney transplant recipients, so it’s a substantial consideration.
If you had indications that active rejection of your kidney had already begun – possibly through a high creatinine test result – you would want to have TRAC Kidney ordered for you, as the acute rejection could be confirmed with a blood test instead of a biopsy procedure.
It is important to speak with your healthcare team and follow their advice to prevent organ transplant rejection. In general, there are several key components to maintaining a healthy transplant:
Take your medications as prescribed. The immunosuppressant therapies prescribed by your transplant team are like a shield that helps keep your immune system from harming your new kidney.
Keep up with medical visits. During your regular check-ups, your transplant team will monitor the health of your kidney and adjust your medication as needed.
Stay healthy. Follow lifestyle guidelines, like eating a balanced diet, staying active, and avoiding tobacco and other harmful substances.
There are many credible free resources for learning about kidney transplantation and issues around rejection.
US Department of Health & Human Services Organ Procurenment & Transplantation Network
Wondering what “silent” rejection is, and why it’s important to catch it early? Visit our patient education website and Get Ahead of Rejection!
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